Epidemiology, outcomes and coronary angiography findings of patients following out-of-hospital cardiac arrest

Objectives: Out-of-hospital cardiac arrests [OHCAs] are a leading cause of death worldwide. However, data regarding the management and outcomes of affected patients are lacking in the Middle East. The current study aimed to present the angiographic findings and outcomes of patients presenting with OHCA in Muscat, Oman

Methods: This retrospective study took place between January 2012 and December 2016 at the Sultan Qaboos University Hospital [SQUH], Muscat, Oman. All adult patients who presented following an OHCA to the Emergency Department of SQUH during the study period were included. Demographic and clinical data were collected from electronic medical records

Results: A total of 216 patients were included in the study. The majority [63.9%] presented after having collapsed, while 22.3% presented with chest pains. Asystole was the most frequent initial cardiac rhythm [62.5%], with only 10% having ventricular tachycardia/fibrillation. Very few patients [1.4%] had received cardiopulmonary resuscitation [CPR] prior to presentation. In total, 85 patients [39.4%] returned to spontaneous circulation [RSC]; of these, post RSC electrocardiography revealed an ST-segment elevation in 41.2% and normal findings in 23.5%. There were 63 patients who underwent coronary angiography, with 28 requiring stenting. Overall, 13% of patients survived and were discharged, although three survivors suffered permanent hypoxic brain damage

Conclusion: The overall survival rate of patients who had experienced an OHCA was low. Education programmes should focus on the benefits of immediate CPR for individuals experiencing an OHCA, with more opportunities for CPR training to be made available to the general public in Oman

Comparison of the efficacy and safety of chlorpromazine with verapamil for the treatment of acute opioid abstinence syndrome

To compare the efficacy and safety of chlorpromazine with Verapamil in patients with Acute opioid Abstinence Syndrome. Single blind comparative clinical trial was conducted at Department of Pharmacology, BMSI, JPMC, Karachi, over the period of one year. Forty opiate-dependent subjects were chosen at random who were in search of opioid abstinence treatment. All patients were grouped into two groups, group-I received chlorpromazine 150 mg/day and group-II received Verapamil 120mg/day in divided doses. Every patient completed the management plan while admitted in the hospital for 10 days. The chlorpromazine showed decreased efficacy and safety, whereas verapamil showed clinically pertinent decline in the subjective symptoms of acute opioid abstinence syndrome. The study showed Verapamit is superior to chlorpromazine in the treatment of opioid abstinence syndrome indicated by better reduction of withdrawal symptom scores, excessive opioid urinary excretion and lees side effects. The superiority of verapamil over chlorpromazine in controlling opioid abstinence syndrome may indicate that calcium is involved in the initiation and development of opioid abstinence syndrome

Calcium channel blocker verapamil: a nonhormonal option for hot flashes management in patients with acute Opioid Abstinence Syndrome

Given the problems associated with hormonal therapy, and the prominent problem of hot flashes, there is a need for nonhormonal agents to alleviate hot flashes. Calcium ions play an important role in brain synaptosomes. This study was conducted to investigate the efficacy of calcium channel blocker verapamil in hot flashes, the most frequently reported subjective symptom of acute opioid abstinence syndrome. The study was a 10 days single blind, random-assignment, inpatient trial for the patients of opioid abstinence syndrome with a very common symptom, the hot flashes. Twenty patients were given Verapamil, 120mg/day in divided doses. All patients, who have completed the treatment program, stayed in the hospital for 10 days. Mean absolute change scores of number of hot flashes per day at endpoint, with baseline scores, showed a highly significant decline with verapamil treatment program. The investigators found a benefit of verapamil in hot flashes

Gingival hyperplasia; during verapamil therapy in hypertensive patients

Calcium ion plays an important role in gingival hyperplasia due to its effects on hemostatic balance of epithelial differentiation and apoptosis. It is hypothesized that non inflamed gingival fibroblasts are less active and do not respond to circulating drugs. While the fibroblasts within inflamed tissue are in an active state. Hence a study was conducted to investigate and assess the relationship between oral hygiene and severity of gingival hyperplasia in hypertensive patients receiving verapamil. In the present comparative investigation, clinical periodontal parameters were determined. Thirty hypertensive patients who were taking verapamil 240 mg/day in divided doses selected randomly. Subjects were divided in to HEL groups. A gingival enlargement score was assessed for each patient by using hyper plastic index, while using plaque index assessed the oral hygiene status. There were highly significant differences between test groups E and L, when they were compared with group H [Healthy group]. Mean plaque index and hyper plastic index varied between test groups H, E and L. The differences showed statistical high significance. Oral hygiene plays a decisive role in the development of gingival hyperplasia and the incidence can be controlled successfully by meticulous professional and individual oral hygiene

Effects of Azelastine and Sodium cromoglycate in the inhibition of Broncho - Constriction of ovalbumin sensitized Lung Parenchymal Tissues of Guinea Pigs in Vitro

To see the ability of Azelastine and Sodium cromoglycate in influencing antigen induced contractile responses in isolated parenchymal tissues of Guinea pig in vitro. An experimental study. Department of Pharmacology and Therapeutics of Basic Medical Sciences Institute, Jinnah Postgraduate Medical Center [JPMC], Karachi during 1998. The Guinea pigs [n=10] were sensitized with ovalbumin and their parenchymal strips were exposed to different concentrations of ovalbumin to observe the EC50. Each sensitized parenchymal strip was treated with either Azelastine or Sodium cromoglycte in an organ bath for 10 minutes and treated with EC50 ovalbumin and contraction was recorded by Grass Polygraph model 7B. EC50 [n=6] of parenchymal strips [0.3x10-6 + 0.16x10-6g/ml] produced a mean response of contraction 9+0.44mm. Azelastine in concentration of 10-9 g/ml did not show any inhibitory effect but as the concentration increased to 10-8 g/ml, marked inhibition was recorded and with further increase in concentration by 10-7 g/ml, it completely antagonized the EC50 induced contraction. Sodium cromoglycate did not show any inhibition at concentration 10-8 g/ml while at higher concentration of 10-6 g/ml, it showed complete antagonism. Ovalbumin induced contraction of sensitized lung parenchymal tissues of Guinea pig in vitro is dose dependent and controlled better with Azelastine than Sodium cromoglycate

Evaluation of combined effect of verapamil and ranitidine on the volume and acidity of carbachol induced gastric secretion

This study was conducted to observe the effect of H2-receptor antagonist Ranitidine and calcium channel blocker Verapamil on the volume, free and total acidity of carbachol induced gastric secretion. Twenty four albino rats of Sprangue Dawley strain weighing 150-200 grams were used. Animals were divided into Four groups. After fasting for 48 hours, pylorus of each animal was ligated, verapamil 10mg/Kg, ranitidine 0.5 mg/Kg and carbachol 600 micro g/Kg body weight were administered intraperitoneally. It was observed that ranitidine significantly reduced both the volume and acidity [p<0.001]. Similarly Verapamil also significantly reduced the volume, free and total acidity when compared to carbachol alone. When verapamil was used in combination with ranitidine 15 minutes before carbachol, there was further inhibition of volume and acidity as compared to ranitidine alone. This reduction was statistically highly significant [p<0.001]. Our study suggests that combined therapy of verapamil and ranitidine may have clinical usefulness in the management of severe peptic ulcer and Zollinger Ellison Syndrome

Calcium channel blocker verapamil. A non opioid treatment for acute opioid abstinence syndrome

Calcium ion plays an important role in acute opioid abstinence syndrome due to its effects on brain synaptosomes. Hence this study was conducted to observe the effects of calcium channel blocker Verapamil as a non-opioid treatment of acute opioid abstinence syndrome. Setting: Twenty healthy opiate-dependent patients seeking inpatient treatment were selected randomly. Verapamil 120mg/day was given in divided doses under single blind protocol. All patients completed the treatment program and stayed in the hospital for 10 days. Verapamil showed a gradual but highly significant improvement in signs and symptoms of acute opioid abstinence syndrome. Verapamil was observed to be highly effective non-opioid treatment of acute opioid abstinence syndrome. Hence verapamil may be given extended clinical trial, because it did not show any adverse effect

Effect of Losartan in ovalbumin sensitised guinea pig's bronchial tissue

To observe and evaluate response to antigen in presence of Losartan, in ovalbumin sensitized guinea pig's bronchial tissue. Design: Twenty five guinea pigs were sensitized with ovalbumin. Isolated strips of bronchial tissue from sensitized animals were used to observe and evaluate the response of ovalbumin in presence of Losartan. Settings: Department of Pharmacology and Therapeutics, Basic Medical Sciences Institute, Jinnah Post Graduate Medical Centre, Karachi. Subject/Five strips of bronchial tissue from sensitized animal were used to determine EC., of ovalbumin. Each bronchial strip was individually incubated for 10 minutes in serial dilution of Losartan 10-5-10-Iglml and then exposed to ovalbumin EC50 Tissue response was recorded on Grass polygraph machine. Losartan caused an overall decrease in antigen responsefrom control ovalbumin EC50 value in sensitized bronchial tissue, along with progressive increase in antigen induced response with increasing concentration of Losartan. Our findings suggest that as Losartan shows a less severe increase in bronchial hyper-responsiveness, it can be used selectively in low doses with caution in patients with history of asthma, until more clinical experience with Losartan is accumulated

Effects of antihypertensive drug captopril on the metabolism in hypertensive NIDDM patients

Ten hypertensive diabetic patients with type 11 diabetes were treated with tablet captopril 25 mg twice a day for 5 weeks. It belongs to the class of angiotensin converting enzyme inhibitors. In these patients mean fasting blood glucose level decreased by 29.04% [P<0.01], plasma insulin level increased by 124.3% [P<0.01], serum cholesterol decreased by 22.56% [P<0.05], serum triglycerides decreased by 3.04% [P=non-significant], HDL-cholesterol increased by 23.46% [P<0.01], LDL cholesterol and VLDL cholesterol decreased by 2.68% [non-significant] and 3.04% [non-significant] respectively. Plasma fibrinogen level decreased by 14.46% [P<0.05]. Both the systolic and diastolic blood pressure showed highly significant decrease [P<0.001]. Weight and body mass index showed non-significant results. The administration of captopril appeared to be not only an effective way of lowering the blood pressure in hypertensive diabetic patients but it also have exerted beneficial effects on the carbohydrate, fats and protein metabolism

Massive pulmonary embolism in pregnancy

Venous thromboembolic disease [VTE], including deep venous thrombosis [DVT] and pulmonary embolism [PE] is not uncommon during pregnancy. High degree of suspicion should be maintained, as many clinical features of VTE are common during pregnancy such as lower extremity swelling and increased respiratory rate. Threshold to investigate VTE should be low as it is associated with significant morbidity and mortality. Diagnostic tests [venous Doppler, echocardiography, spiral CT, V/Q scan, pulmonary arteriography] should be carefully chosen as dictated by the clinical situation and availability of tests and expertise. DVT or hemodynamically insignificant pulmonary embolism may be managed with systemic anticoagulation. Unfractionated heparin requires continuous intravenous infusion and activated partial thromboplastin time should be monitored. Low molecular weight heparin is safe, can be administered subcutaneously and does not require monitoring unless bleeding is noticed. In the absence of contraindications systemic or local catheter-directed thrombolysis should be attempted for hemodynamically significant pulmonary embolism. Surgical thrombectomy should be considered if thrombolytic therapy is contraindicated. After thrombolysis or thrombectomy, long-term anticoagulation is warranted to prevent recurrence. Warfarin is contraindicated in early pregnancy and risk of bleeding is potentially higher late in pregnancy

Role of subantihypertensive dose of lisinopril in regression of hypertensive left ventricle hypertrophy

Left ventrical hypertrophy [LVH]: an independent cardiovascular risk factor is present in a significant number of hypertensive patients. The reversal of LHV is a desirable therapeutic goal in the treatment of hypertension because the prognosis of the patients, whose treatment has led to the regression in cardiac hypertrophy is markdly better than that of patients in whom regression in cardiac hypertrophy fails to be achieved. Lisinopril, an ACE inhibitor has been shown to alter the anatomy of heart positively, even used in subantihypertensive dose, suggesting the mortant role of RAS, in the onset and progression of LVH, whereas moduretic almost did not produce any change in the size of the ventricle despite favourable effect on BP

Comparative study of diclofenac sodium and flurbiprofen in osteoarthritis

A comparative study was conducted to evaluate the therapeutic efficacy of diclofenac sodium and flurbiprofen both non-steroidal anti-inflammatory drugs [NSAIDS] in osteoarthritis. Forty patients of either sex between the ages of 35-60 years suffering from osteoarthritis of at least one knee joint minimum of eight weeks duration were included in the study. Diclofenac sodium exhibited better results by improving the signs and symptoms of osteoarthritis in both high and low doses compared to flurbiprofen. The adverse effects observed were similar in both groups

Beneficial role of alpha tocopherol [vitamin E] in human osteoarthritis

Single bind six weeks study was conducted in 40 patients between the ages of 4 - 65 years of either sex suffering from osteoarthritis of at least one knee joint. Alpha tocopherol exhibited better effects by improving symptoms of pain at rest, pain on movement and pain on pressure as assessed by using a four point scoring system. Limitation of movements and walking time were also recorded but did not show any significant improvement. No adverse effects were noted of vitamin E except in one who complained of insomnia. The beneficial effects of vitamin E can be explained on its well known antioxidant effect, thus stabilizing the lysosomal membrane and inhibiting the release of irritating enzymes cathepsin ribonuclease galactosidases and sulfatases